Recent advances in fixation of the craniomaxillofacial skeleton.

PURPOSE OF REVIEW: Fixation of the craniomaxillofacial skeleton is an evolving aspect for facial plastic, oral and maxillofacial, and plastic surgery. This review looks at the recent advances that aid in reduction and fixation of the craniomaxillofacial skeleton. RECENT FINDINGS: More surgeons are using resorbable plates for craniomaxillofacial fixation. A single miniplate on the inferior border of the mandible may be sufficient to reduce and fixate an angle fracture. Percutaneous K-wires may assist in plating angle fractures. Intraoperative computed tomography (CT) may prove to be useful for assessing reduction and fixation. SUMMARY: Resorbable plates are becoming increasingly popular in orthognathic surgery and facial trauma surgery. There are newer operative techniques for fixating the angle of the mandible. Also, the utilization of the intraoperative CT provides immediate feedback for accurate reduction and fixation. Prebent surgical plates save operative time, decrease errors, and provide more accurate fixation.

Skeletal surgery in sleep apnea.

PURPOSE OF REVIEW: Obstructive sleep apnea (OSA) is a common condition, increasing in incidence along with obesity in Americans. This review looks at skeletal surgery to treat sleep apnea and recent advancements. RECENT FINDINGS: Skeletal surgery for OSA has improved with recent advancements in surgical genioplasty now able to advance the genioglossus as well as inferior mandible muscles without changing aesthetics. Some investigators have called for maxillomandibular advancement to be considered as a first-line therapy over continuous positive airway pressure. SUMMARY: Maxillomandibular advancement appears safe and effective for consideration as a first-line therapy for select patients with OSA.

Presence of biofilm on adult tracheostomy tubes.

We conducted a prospective observational study of tracheostomy tubes with three primary goals: (1) to identify the presence and location of bacterial biofilms on adult tubes, (2) to determine how soon after insertion of a tube the presence of a biofilm could be identified, and (3) to identify the bacterial organisms that formed the biofilms on these tubes. Our study materials consisted of 7 adult tracheostomy tubes that had been changed during a routine outpatient clinic visit or hospital consultation. The tubes were examined for the presence of biofilms on the posterior aspect of the outer cannula; also, specimens were obtained from the posterosuperior aspect of the cuff on the 3 tubes that had a cuff. Samples of 2 to 3 mm were taken from each site and analyzed by scanning electron microscopy. Bacterial biofilms were found on 4 of the 7 tubes; they were present on the outer cannula of 3 cuffless tubes that had been inserted 14 days, 4 months, and 2 years previously and on the cuff of 1 tube that had been inserted 10 days previously. The biofilms were composed of gram-positive cocci in pairs that were likely consistent with Staphylococcus epidermidis.

An unusual presentation of nasal type NK/T-cell lymphoma of the nose.

OBJECTIVES: Case report of a male with a rare nasal type NK/T cell lymphoma that presented as an aggressive nasal infection superimposed with squamous and basal cell carcinoma. A review of the diagnosis, management, and prognosis nasal type NK/T cell lymphoma will be presented. STUDY DESIGN: Case report and literature review. METHODS: Review of the literature for cases of nasal type NK/T cell lymphoma, with particular attention to its presentations. RESULTS: Differential diagnosis includes aggressive infection of the nasal skin, carcinoma, and lymphoma. CONCLUSION: No cases in the literature of NK/T cell lymphoma have been reported that presented with an aggressive infection with initial biopsies that revealed squamous cell and basal cell carcinoma, which led to surgical management and a definitive diagnosis of Nasal type NK/T cell lymphoma.

Intradermal positivity after negative prick testing for inhalants.

OBJECTIVE: Examine the incidence of positive intradermal tests after a negative skin prick test for 24 inhalant antigens. STUDY DESIGN AND SETTING: Retrospective study. Charts from patients who underwent modified quantitative testing (MQT) over a 3-year period were reviewed. Patients were initially tested with Multi-Test II. Subjects with negative wheals to a specific allergen were then tested with a 1:500 weight:volume intradermal injection of that allergen. RESULTS: One hundred thirty-three patients underwent MQT for 24 antigens. Allergens with the highest incidence of positive intradermal wheals after negative prick testing were Dermatophagoides pteronyssinus and Dermatophagoides farinae at 26.67%. Allergens with elevated incidence of positive intradermals included fusarium, cockroach, cocklebur, rough marsh elder, and ragweed, all with incidences of 16% to 19%. CONCLUSION: Positive intradermal responses after negative prick testing occur commonly. Future study is needed to determine the generalizability and clinical significance of these findings. EBM RATING: C-4.